Revision:

ECFA-PH-87-4 P-4iiCH 1987

(BERC)

STATE PLA.1; UNDER TITLE X I X OF THE SOCIAL SECURITY ACT

Hedical Assistance Program Stzte/Territory:
r-1 c~,-,I7

TABLE OF CONTENTS
SECTION
S t a t e P l a n Submittal Statement

PAGE NUHBERS

. . . .. . . . SECTION 1 - S I K C L E STATE AGElJCY ORGANIZATIOlJ . 1.1 D e s i g n a t i o n and Authority . . . . . . . i.2 O r ~ a n i z a t i o nfor Administration . . . .
1.4 State Hedical Care A d v i s o r y Connittee

. .. . . . . . . . . . .. . . . . . . . . . . . .. . . . .. . . .. ... ......
. .

1
2

2
7

. . . ., . . . . . .

0 .

23 , -c 6

Approval Date OCT 2 6

~ f f e c t i v eDate

:I!i
'

!:

1 '987

Supersedes

HCFA ID:

1002P/0010P

Revlsicn:

H2FA-PH-87-4 YXtCH 1987

SECTION

(BERC)

. ; ECTION

ELIGIBILITY

2.1 A p p l i c a t i o n , Determination of Eligibility and Furnishing Medicaid . . . .

2.2

2.3

. . . . . . . . . . 10 C o v e r a g e and Conditions of Eligibility . . . . . . . . . . . 12 Residence . . . . . . . . . . . . . . . . . . . . . . . . . . 13

... .

2.6 Financial Eligibility

2.7 Kedicaid Furnished

. . .. .. . . ... . .. . .. . . . Out of S t a t e . . . . . . .. . . . . . . . .

16
18

l!ryj---+3
Supersedes TIi No.
Approval Date

OCT 2 6 887

Effective Gate JUL 0

1 1987

HCFA ID:

1032P/0010P

Ilevision:

HCFA-PM-87-4 March 1987 .

(BERC)
OMB N0.:0938-0193
--- -

. .

-PAGE NlJMBERS

SECTION SECTION 3 - SERVICES: 3.1 3.2 3.3

GENERAL PROVISlONS.. ...................................... 19

Amount, Duration, and Scope of Services. ........................................ .19 Coordination of Medicaid with Medicare Part B. .................................. 29 Medicaid for lndividuals Agc 65 or Over in institutions for Mental Diseases.. ................................................ .30 Special Requirements applicable to Sterilization Procedures.. ............................................................

3.4

..3 1

3.5

Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries.. ................................................. ..3 1a Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period.. ............................................ .3 1b Mandatory Managed Care Enrollment.. ............................................. 3 1e

3.6 3.7

TN No. 03-009 Supersedes TN No. 87-08

JAN
Approval Date Effective Date HCFA ID: 1002P/0010P

F.evi5

icn :

hJFh-PH-87-4 uARCH 1987

SECTiON

(BERC 1
PACE l W 2 E R s

SEC';:Ct:

.G E l I i F J L PROGRXH ADKINISTRATION

. . . . . . . . . . . . .

32

4.1 H5thods of Administration

. . . . . . . . . . . . . . . . . .

32

4 . 2 Hearings for Applicants and Recipients

4.3 Safeguarding Infornation on Applicants and Recipients . . . . . . . . . . . .
4.t ~edicaidQuality Control

. . . . . . . . . . .
. . . . . . . . . . .

33

34

. . . . . . . . . . . . . . . . . .

35

4.5 Eedicaid hgency Fraud Detection and Investigation Program . . . . . . .

4.6 Reports

. . . . . . . . . . . . . 36
37
38

. . . . . . . . . . . . . . . . . . . . . . . . . . .

4.7 Xaintenance cf Records

. . . . . . . . . .

. . . . . . . .

4 . 8 Avziiability of Agency Progrzq Kanuals

4.9 Reporting Provider Payments to the

. . . . . . . . . . .

39

Internal Revenue Service

4.10 Free Choice of Providers

. . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . . . . . . . . . 41

4.11 Relations with Standard-Setting and Survey Agencies

. . . . . . . . . . . . . . . . . . . . . . 42 4.12 Consultation to Medical Facilities . . . . . . . . . . . . . 4 4

4.13 Required Provider Agreement

. . . . . . . . . . . . . . . . . 45

4;14 Utilization Control

4.15 Inspections of Care

. . . . . . . . . . . . . . . . . . . . . 46
. . . . . . . . . . .
51

in Skilled Nursin6 m d Intermediate Care Facilities and Institutions for Mental Diseases . . .

4.16 Relations with State Health and Vocational

. 4.17 Liens and Recoveries . . . . . . . . . . . . . 4.18 Cost Sharing and Similar Charges . . . . . . . 4.19 P a ) r . e n t for Services . . . . . . . . . . . . .
Rehabilitation Agencies and Title V Grantees

. . . .

. . . .

.. . . . . .-..

. . . 52 . . . 53 . . . 54
. . .
57

i KO . 5~;er;edes

87 . 0 ' 8
Approval Date-

"

is;

It

Effective Date

. . . "3 - ...
'
1

T I : 1.0 .

HCFA ID:

1032P/001OP

Revis ion:

HCIA-PM-90- 2 JANUARY 1990

( BPD)

R Q I m PACE M 4 . 2 0 D i r e c t Payments t o C e r t a i n R e c i p i e n t s f o r

Physrcians' o r Dentists' Services

. .

. . . . . . . . . .
.

67

4 . 2 1 P r o h i b i t i o n Against Reassignment of

P r o v i d e r Claims . . . . .
4 . 2 2 Third P a r t y L i a b i l i t y .

. . . . . . . . .

. . . . . . .
.

68
69

. . . .

. . . . . . . . . .

. .

. .

4 . 2 4 S t a n d a r d s f o r Payments f o r S k i l l e d Nursing

and I n t e r m e d i a t e Care F a c i l i t y S e r v i c e s
4 . 2 5 Prostam f o r Licensing A d m i n i s t r a t o r s

. . . . . . . . .
.

. 72
73

of blurring Homes

. -.
.

. .

. .

.. .

. .

. . . . . . . . .

4 . 2 7 D i s e l o s u t e of Survey Information

and P r o v i d e r o r C o n t r a c t o r Evaluation
4 . 2 8 Appeals Proces8 f o r S k i l l e d Nursing

. . . . . . . . . . . .

75

and I n t o r m e d i a t e Cars P a c i l i t i a s
4 . 2 9 C o n f l i c t of I n t e r e s t P r o v i s i o n s

. . . . . . . . . . . . .
.

76

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . .
. . .

77

4 . 3 0 Exclusion of Providers and Suspension of

P r a c t i t i o n e r s Convicted and Other I n d i v i d u a l s

4 . 3 1 Disclomrm of I n f o m a t i o n by P r o v i d e r s

78

andFiscalAgants

. . . . . . .

. . . .
.

79 79

4 . 3 2 I n c o w and E l i g i b i l i t y V e r i f i c a t i o n System 4 . 3 3 Medicaid E l i g i b i l i t y Cards

. . . . .

f o r H o a u l m s s Zndividuals

. . . . . . . . . . . . . . . . . .
.

798 79b

4.34 S y s t c ~ t i c Alien V e r i f i c a t i o n f o r E n t i t l e m a n t s

. .

. . .

4 . 3 5 P.rwdies f o r S k i l l e d Nursing and Intmmmdiata Cam P a c i l i t i m s t h a t D o l o t Meat Requirements of ~ a r t i c i p a t i o n . . . . . . .

. . . . . . .

7 9 ~

Tl l o . 9 0 4 5
Supotrades .qpproval

at.

,,/--/:,/

K f f o c t i v a Data HC?A

. : m u 1. ; 3 9 ~
100m/wloP

T1 Ilo.
ID:

E610-8C60

'ON W O

(3U30)

L861 H 3 W t - L g-Rd-VJ3i{

UOT5 Jh3H

Revision:

HCFA-PM-91- 4 August 1 9 9 1
SECTIOIJ

( BPD )

OMB No. 0938-

PAGE NUMBERS

SECTION 7 - GENERAL P R O V I S I O N S

....... 7 . 1 Plan Amendment8 . . . . . . . . . . . 7 . 2 Nondiscrimination . . . . . . . . . . 7.3MaintenanceofAFDCEffort . . . . . 7 . 4 StateGovernor1a Review. . . . . . .

... ..

... ... ... ...

.. .. .. ..

. . . . . 86 . . . . . . 86 . . . . . . 87 . . . . . . 88 . . . . . . 89

Supersedes
*a.

...#.

Approval Date

?
HCFA ID:
7982E